Integrated, collaborative disaster response networks.

Following the one year anniversary of Hurricanes Katrina and Rita, and the recent and current publications in the Southern Medical Journal regarding medical preparedness during times of disaster (1,2) it is appropriate to reflect on what we have learned and what we should we do differently next time.

The immediate response to disaster; extrication, rescue, and medical care is local. Local leadership always emerges, and the more prepared the local leadership, the better the response. Should the local disaster leadership require outside assistance, such assistance is always 72 to 96 hours away. From a medical standpoint, especially for medication refills, renal dialysis, trauma, surgical, diabetic treatment, hypertension, asthma, and even mental health support, it is the immediate response that results in the best medical outcome. Such immediate medical responses are most often locally managed, supervised, and rendered.

During a major catastrophic event, total loss of infrastructure can overload the local emergency rooms and hospitals to the breaking point, in regard to personnel, fuel, supplies, and continuing care. Establishing a clinic at the shelter will aid in preventing surge or "overload" at local emergency rooms and clinics. Many public safety net health systems are not well organized or supported, and as such, may not be able to respond as robustly as necessary. Any health system or community that responds with significant rescue, shelter, and medical care should have the ability to invest significant capital equipment and money, as reimbursement from FEMA is never complete nor timely.

The medical branches and support for most Emergency Operating Centers (EOC) is provided by local governmental public health physicians. Whereas it is essential to address public health issues in every disaster, EOCs and Joint Unified Commands benefit from also having local, clinically active physician leaders from the medical societies, medical schools, and trauma systems incorporated into the chain of command. Integration of outside credentialed and licensed medical professionals must be coordinated with the medical command of the local Joint Unified Command.

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Having a method of rapidly registering and tracking all who enter a shelter and/or seek medical care will aid not only inpatient care, but also in reuniting families, and in long-term health tracking. Such a system is not readily available and functional.

Houston served as a sister rescue city to New Orleans, although no such pre-event arrangements existed. Rudimentary communications between physicians in New Orleans and Houston allowed for an understanding of the challenges and medical infrastructures which would be required. Both cities recognized that governmental and hospital disaster plans were inadequate to address the many new management, logistic, communication, and patient evacuation needs of a disaster of this magnitude. A great need exists for an integrated, collaborative network to respond to a societal evacuation and medical care plan. The article by Rozeman and Mayeaux in this issue of Southern Medical Journal gives one effective example of such a network.

References

1. Gavagan TF, Smart K, Palacio H, et al. Hurricane Katrina: medical response at the Houston Astrodome/Reliant Center Complex. South Med J 2006;99:933-999.

2. Rozeman P, Mayeaux E. Hurricanes Katrina and Rita: case study of disaster recovery South Med J 2006;99:1329-1333.

Kenneth Mattox, MD, and Thomas Gavagan, MD, MPH

From the Baylor College of Medicine, Houston, TX.

Reprint requests to Thomas Gavagan, MD, MPH, Baylor College of Medicine, 3701 Kirby, Suite 600, Houston, TX 77098. Email: [e-mail]

Accepted September 6, 2006.